Click on below Questions to Learn More
Dental implants are titanium cylinders that are used to replace the root of the tooth in the bone. When you have a missing tooth, you can have an implant placed and that is like having the root back. Once the implant is placed, then you have multiple options. In most cases we are replacing individual teeth and we put a post, called an abutment, through the gum tissue and then place a crown on it, just like you would a tooth. In other cases like dentures, you can put different types of attachments to secure the denture to the implant in order to stabilize the denture and increase functionality. Dental implants are a way of reconnecting whatever it is that you are using to chew with to the bone itself so that it functions more like natural teeth again.
Dental implants are the closest thing that we have to replacing a tooth. In my opinion, it is one of the best things to come along in dentistry in years. In the past when you lost your teeth, you were stuck with dentures or partial dentures and they were a very poor substitute for your natural teeth. A natural denture is really just a piece of plastic squeezing the gum tissue between the hard plastic and the bone. Using dental implants, we can put that pressure on the implant, in the bone, just like a natural tooth giving them the ability to chew as you would with natural teeth. Now we have the ability to can make dentures function twice a well as before because we can reconnect them to the bone and stabilize them.
Dental implant procedures have improved and changed dramatically over the years. The actual implant procedure is to place the implant body in the bone, let the bone grow to it or integrate and then treat it as if it were a root of a tooth and place a crown on it or attachment for your dentures and things of that nature. The most common procedure now is to not even make an incision, but to make an opening through the gum tissue and using the specialized drills to prepare a site in the bone, so you can place the implant in the bone. With the newer surfaces on the implants they are integrating much more rapidly than they used to. We are looking at six to eight weeks for most cases now. With implant cases in the past it used to take six months. In most cases, because of the earlier stabilization of implants, we can put a temporary crown on that implant immediately, so the patient is never without the tooth once you start the process. We are doing a lot more of immediate replacement if a tooth is lost. In most cases we can put an implant in the same day and place a temporary on it. This is vital because that allows us to maintain the architecture of the gum tissue. It looks more natural on the finished product and with fewer procedures than we used to have to do.
In many cases, individual implants can be done just under a local anesthetic. If we are doing multiples, I usually recommend sedation not because of the pain but because of the psychological part of knowing what is being done. It just makes it a more psychologically comfortable procedure.
The improvement of the surfaces of the implants has really changed this dramatically from months to weeks. In most cases, we can place an implant and be ready to restore it within 6 to 8 weeks. Anywhere from 9-12 weeks and you are done. For example, if a patient comes in and a tooth has to be taken out, we can immediately place an implant with a temporary on it. Patients are happy with this and it looks great and it’s a just a matter of letting the bone integrate and letting the tissues heal. Then they come back in six to eight weeks and we will take the temporary off, get a repression of the tissue and implant, and send that off to the laboratory and put the temporary back on there. Then patient goes homes for two or three more weeks and comes back and then we get the permanent crown put in.
So it’s only about three visits?
Yes in most cases. Three visits spaced for healing time. With that being said, a lot of our implant patients are major re working of their entire bite, and those will take us a year sometimes.
In most cases, the answer is no. It’s relatively painless. It’s less painful than having teeth taken out. If all of the parameters are correct, if you have enough bone and the tissue is healthy, then putting an implant in causes a little soreness in the gums.
Where you might get into an area where it is more painful if you have had teeth missing for a long time, like a denture wearer and the tissue is really thin in the lower jaw when you make an incision that places the implants you are going to get more swelling and that causes some discomfort with it. However those people, almost every one of them wants to be able to experience the difference of being able to use their dentures that are connected to implants, versus what they used to have. They would go through that procedure in a heartbeat because it changes their lives. There are a few areas where there is discomfort involved but the majority, like replacing a single tooth that has been lost within a few years, usually that is a fairly painless procedure.
Dental implants are one of the most successful things that we are doing. We are having 95-98% success rates at five years and ten years. Implants really became popular when the Swiss did their 25 year launch study and showed a 95% success rate with dental implants.
Anyone who has lost teeth that need replacement should consider dental implants. For those who want to improve their ability to chew and restore the feeling of wholeness to their life again is a candidate for dental implants.
Ideally we want to place on implant for each tooth that is missing.
However, it can vary quite a bit. In order to determine that we have to consider the following questions: What type of bite does the individual have? How strong is their bite? What kind of bone they have left? How long of an implant can we place?
If they get well integrated, the patient is taking care of them getting their teeth cleaned on a regular basis, and the restorative dentist is doing their job, then theoretically they should last the rest of the patient’s life. Once the implant bonds in there, if you bleach teeth, things like that, you can replace a crown. One thing that I do caution is that a patient not get stuck on replacing a missing tooth with an implant without looking at the entire mouth and deciding if you want to do orthodontics at any time in your life you should probably do that prior to placing an implant. We used to say that once an implant is in there you can’t move it, but you can but it is a big procedure to have done.
Occasionally an implant will fail but it is pretty rare. If it does, it is usually immediate and replacing it with another implant seems to work fine. Occasionally if the tooth has been missing for a long time or there was an infection present, we have to wait to let the bone or graft bone heal, and then we will place the implant.
Once the implant is placed, it is absolutely critical that the restoring dentist understands the difference between implants and natural teeth. This is important especially when you have implants and natural teeth side by side. The implants are held into the bone and they do not move at all. However, natural teeth are held into the bone by ligaments and they will give, so you have to be very precise in the way that you make the bite or the occlusion on an implant with natural teeth. So that when the patient bites hard, they all hit evenly. When biting lightly, you don’t want the implant to be hitting as hard as the natural teeth because when they bite hard that means the implant is going to take more force and that is where you might get a failure five years out.
Let’s say you have one missing tooth, we have a decision to make because you can replace it that tooth with a bridge, (where you trim down that tooth and the ones on the sides and place a three unit bridge, a crown on each side and then a false tooth in between) or an implant. One of the down sides of choosing a bridge is that these teeth on the sides may have been good healthy teeth and now you are trimming the enamel off to put these crowns on there and you do not put anything back on the bone, so the bone continues to shrink and that causes a visual defect in the bone.
If you have trouble in the future then you are involving three teeth instead of just one if you have an issue with that bridge. We also know that bridges can to fail more frequently at about the 10th or 11th year mark than implants do. If you get a bridge in there at a young age, you can pretty well know that you are going to have to replace it once or twice in your life.
If you take that same situation and you place an implant in the bone to maintain the bone and you put a post, an abutment, and a crown, then that is individual restoration. You have the teeth beside it that are still healthy and now you can floss and everything, it is easier to clean than a bridge and the implant will last much longer because it can’t decay as long as the bone is healthy around it. The cost difference between putting an implant, abutment and crown and doing a bridge is only a few hundred dollars, so its very similar in cost in that situation.
When you are talking about supporting dentures, it depends on how many implants you put in, it depends on what kind of quality of bone there is to start with, whether or not you have to do grafting or not, I can say this without hesitation that putting implants to support a lower denture it is such a quality of life issue.
Dentures are a sad story, particularly lower dentures. Think of the lower jaw, there are two different types of bone: the skeletal body of the jaw and the dental bone (the bone that supports the teeth). The only purpose for this dental bone to be there is to support the tooth roots and it is stimulated by function in those teeth to keep it healthy. As soon as you take it out, this bone starts to shrink. The problem is then compounded by putting plastic on top of it. The dentures are pushing down and the bone reacts to pressure; if you push on it, it will resorb, if you pull on it, it will get stronger and grow. So if you are pushing down with a denture and it causes this to speed up in most people and you can end up I have seen lower jaws so thin that you rub your fingers on them and you could break them. So what our goal is with implants is to try to get them to put some implants in there because then the implants maintain this bone they stop this progression. For two reasons, one is you have something in there stimulating the bone, secondly the force of your denture is more of the implants so it is spread down more into the bone and not just on the top surface so it stops the resorption process. This person will be ten times healthier in fifteen- twenty years later.
Dental implants are such a life changing experience that the cost is secondary for those who really need it.
You brush them. We usually recommend using a rotary brush that will get underneath the gums a little bit. We also recommend water picks on large settings and using some sort of mouth wash or a medicated mouth wash, that will keep bacteria from getting in there and causing infections.
What we are finding is there is a lot better success rate with implants than there was with their natural teeth. This is because a natural tooth is sitting in the bone but has a ligament space between the bone and the tooth root. This makes a tooth more susceptible to bone loss than an implant is because of that space between the root and the bone where the toxins can get in. With proper home care, people with periodontal problems have very high success rate with implants.
It used to be that a lot of people placing implants would not put them in people that smoked. The reason for that is we were very concerned about our success rate. Smoking does interfere with anything in the human body including dental implants but that doesn’t mean that if you smoke you can’t have dental implants. In the last two years I have had one implant that I had to replace and it was in a smoker because it did not integrate initially. However, we put another on in and it worked fine. But the success rate might go down from 95-98% to mid 80s with smokers so it is still pretty successful. A smoker needs to know when they come in that that is an increased chance that it will be rejected and if it is they are going to pay for the second implant. If they are a smoker, they may have more complications.
Improving the quality of life- a denture patient, whether they are aware of it or not, starts choosing food based on their ability to chew a certain food. People are all the time saying “ohh I seem to be doing fine because I am gaining weight”. Well one of the reasons they are gaining weight is that they are not longer eating proper roughage in their diet. Salads, for example, are one of the hardest things for a denture wearer to eat. The healthy foods are usually the ones that you have to chew and if you can’t chew your food well, then it is not digested well and you start going to softer foods which often times contain more carbohydrates, like pastas and things like that or more fatty type foods. So yes you are gaining weight but you are not getting proper nutrition. Health is an issue.
The fact that that bone is lost on the lower jaw; there is a little opening inside the jaw where your bicuspid teeth normally are where the nerve comes out through the chin and lips. That nerve opening ends up on top of the ridge, so every time you bite down on your denture you get an electric shock of pain going through there.
Being able to kiss your loved ones without your dentures slipping back in your mouth is a big issue. I have seen grown men cry once they got implants because they could kiss there wife again.
The fact that we can place teeth in the proper relationship to the soft tissue takes ten years off the face sometimes because the lips are supported properly. You can open the bite properly that is difficult to do when you are just dealing with plastic sitting on gums.
Most people comment on their ability to go back and eat the foods they like again. People can go out to dinner and not be self conscious to go out in public. Also, psychologically it gives you that feeling that you are a little more whole than you were before, because they are attached instead of free floating. We can change lives. I really enjoy working with people with dentures because of the dramatic change that you can make in their lives.
Yes. You can recreate youthfulness to the appearance and increase the effectiveness of the dentures at the same time.
One of the issues impacting your appearance with dentures is that your bone actually shrinks when the teeth have been missing. There is a neutral zone, where there is equal pressure between the lip and the tongue. This is where the denture must be placed. That neutral zone changes over time and as the jaw bone shrinks after the teeth have come out. That is why you see so many people with dentures that look kind of flat in the lower third of the face. You have to keep moving those teeth back with successive dentures to find that neutral zone so that the denture is as stable as it can be. When you place implants to stabilize that lower denture you can bring those teeth back out so they can support the lip like they were before.
That is our goal every time. Good dentistry is dentistry that looks like teeth and not dentistry. In the last five years there has been dramatic improvements on our understanding of the different techniques that can be used to maintain the architecture of the soft tissues and the gum tissues, which is always the real critical part. We used to have an issue with the implant causing a darkness showing through the tissue. Now we have zirconium or white ceramic abutments that can be custom made and then when you put a ceramic crown on that, it looks like a natural tooth. Even when doing an exam sometimes we get fooled a little bit. That’s great! So yes they can look very natural with the proper restorative procedures combined with the real artist ceramist in the laboratory.
As a restorative dentist, it gives me the great opportunity to take care of the positioning so the rest of the restoration can look its most natural and a patient who comes here does not have to go to multiple doctors. I can place the dental implants, I can restore the dental implants and get it all done in one place it saves them time and money. There is not an overlap of procedures that different dentists are charging for.